Correspondence

Alternative Therapies in Childhood Cancer

N Engl J Med 1999; 340:569-570February 18, 1999

Article

To the Editor:

Coppes et al. (Sept. 17 issue)1 point to the importance of educating parents about the dangers of alternative therapies, but it is also important to report parents to child-welfare authorities if the doctor believes that the parents' refusal to accept proven therapies may be putting the child's life at risk.

Ozzie Orbach, M.D.
704 Peninsula Blvd., Woodmere, NY 11598

1 References

1. 1

   Coppes MJ, Anderson RA, Egeler RM, Wolff JEA. Alternative therapies for the treatment of childhood cancer. N Engl J Med 1998;339:846-847
   Full Text | Web of Science | Medline

To the Editor:

We strongly agree with the assertion that alternative therapies must be subjected to scientific assessment.1 This is true not just when alternative treatment is chosen instead of conventional treatment but also when the two are used concurrently. We recently saw a seven-year-old child at the IWK Grace Health Center in whom a mixture of naturopathic remedies reduced the bioavailability of oral mercaptopurine used as maintenance therapy for acute lymphoblastic leukemia.

Why parents and patients choose alternative therapies in the face of medical practice, which is now on a firmer scientific footing than ever before in its history, is a question that is difficult to answer. In a study of children with cancer, we found that 42 percent used alternative or complementary therapies, usually simultaneously with or following conventional therapies,2 a proportion similar to that in studies of adults with cancer.3 When parents were asked why they chose alternative therapies for their children, the majority (82 percent) said that they wanted to do everything possible. It is the argument of “doing everything possible” that is most difficult to counter. It calls for preemptive education and discussion with families and patients about the known risks and possible benefits of alternative therapies, with the recognition that “doing everything” may indeed be harmful.

Conrad Fernandez, M.D.
Allan Pyesmany, M.D.
IWK Grace Health Center, Halifax, NS B3J 3G9, Canada

Cindy Stutzer, R.N.
British Columbia's Children's Hospital, Vancouver, BC V6H 3BV4, Canada

3 References

1. 1

   Angell M, Kassirer JP. Alternative medicine -- the risks of untested and unregulated remedies. N Engl J Med 1998;339:839-841
   Full Text | Web of Science | Medline

2. 2

   Fernandez CV, Stutzer CA, MacWilliam L, Fryer C. Alternative and complementary therapy use in pediatric oncology patients in British Columbia: prevalence and reasons for use and nonuse. J Clin Oncol 1998;16:1279-1286
   Web of Science | Medline

3. 3

   Cassileth BR, Chapman CC. Alternative and complementary cancer therapies. Cancer 1996;77:1026-1034
   CrossRef | Web of Science | Medline

Citing Articles (7)

Citing Articles

1. 1

   Jocelyn Y. Ang, Shibani Ray-Mazumder, Sharon A. Nachman, Chokechai Rongkavilit, Basim I. Asmar, Clement L. Ren. (2005) Use of Complementary and Alternative Medicine by Parents of Children with HIV Infection and Asthma and Well Children. Southern Medical Journal 98:9, 869-875
   CrossRef

2. 2

   K. F. Tam, D. K. L. Cheng, T. Y. Ng, H. Y. S. Ngan. (2005) The behaviors of seeking a second opinion from other health-care professionals and the utilization of complementary and alternative medicine in gynecologic cancer patients. Supportive Care in Cancer 13:9, 679-684
   CrossRef

3. 3

   Yong Cui, Xiao-Ou Shu, Yutang Gao, Wanqing Wen, Zhi-Xian Ruan, Fan Jin, Wei Zheng. (2004) Use of complementary and alternative medicine by Chinese women with breast cancer. Breast Cancer Research and Treatment 85:3, 263-270
   CrossRef

4. 4

   Paula C. Fletcher, Juanne Clarke. (2004) The Use of Complementary and Alternative Medicine Among Pediatric Patients. Cancer Nursing 27:2, 93???99
   CrossRef

5. 5

   Marian L. Neuhouser, Ruth E. Patterson, Stephen M. Schwartz, Monique M. Hedderson, Deborah J. Bowen, Leanna J. Standish. (2001) Use of Alternative Medicine by Children with Cancer in Washington State. Preventive Medicine 33:5, 347-354
   CrossRef

6. 6

   Eric A. Jackson, Tina Kanmaz. (2001) An Overview of Information Resources for Herbal Medicinals and Dietary Supplements. Journal of Herbal Pharmacotherapy 1:1, 35-61
   CrossRef

7. 7

   Kara M. Kelly, Judith S. Jacobson, Deborah D. Kennedy, Steven M. Braudt, Mita Mallick, Michael A. Weiner. (2000) Use of Unconventional Therapies by Children With Cancer at an Urban Medical Center. Journal of Pediatric Hematology/Oncology 22:5, 412-416
   CrossRef